A recent article in Health Affairs provides some fascinating information that only confirms what National Association of Addiction Treatment Providers member organizations have been reporting for years.

This study is the first to examine trends in addiction treatment by the privately insured. The data comes from the Medstat MarketScan database, a claims database from large employees. The sample included almost four million covered lives, which included employees, their dependents, and early retirees of several companies. This sample represents approximately two percent of the population with private employment-based insurance coverage.

While this study needs to be replicated, the findings are significant and beg for some conclusions to be drawn and critical questions to be raised. In particular, the results should be viewed alongside of reports by the federal government -- incidence of addictive disorder has not been decreasing and federal and state dollars spent on addiction treatment have increased.

• Beneficiaries using any substance abuse services declined by 23 percent from 1992 to 2001. In 1992, 0.64 percent of the covered lives examined (approximately 25,600 beneficiaries) used substance abuse services or received services for which the plans provided reimbursement. By 2001, that number had declined to 0.49 percent or 19,600 individuals. The decline was evident in all categories of treatment modalities. During that period, the federal government increased its spending on addiction treatment and reported report no decline in the need for treatment services via its annual household survey.

• Total dollars paid for addiction treatment per covered life and adjusted for constant dollars dropped from $21.16 in 1992 to $4.46 in 2001. By only looking at these numbers, one would assume that we solved the addiction issue during those ten years! How else do we explain the dramatic drop in expenditure per covered life during the past 10 years?

• In terms of real people, in 1992, 31,701 people were identified with an addiction treatment claim. In 2001, the number had dropped to 18,327. Are persons with addictive disease disorder self-selecting out of employer-sponsored health insurance? Does the fact that 12,000 fewer individuals filed claims in 2001 than 1992 suggest that there is a cost-shifting to the public sector, or are more persons simply not accessing their benefits and going the self-pay route?

• Overall, addiction treatment spending per covered life fell by 73.5 percent, and fell from 1.16 percent of total health expenditures in 1992 to 0.2 percent of total health care expenses in 2001.

The "why" to this decline begs for examination and response. This study simply cannot be left on a shelf. More complete analysis of the data is needed, more accountability by those purchasing health care plans is needed, and more accountability of those managing the plans must be demanded.

Likewise, we must all commit ourselves to providing employers with the best information available on the return on investment for providing addiction treatment. This may be the single most important task for the entire addiction treatment community - to make uniform the collection and sharing of information related to savings realized as a result of providing addiction treatment. Real cost savings presented to real business persons will result in those employers demanding that timely and quality treatment be provided to their employees so that they will realize savings in the area of workers' compensation claims, accidents, and absenteeism.

Citation
Mark TL and Coffey RM. "The decline in receipt of substance abuse treatment by the privately insured, 1992 - 2001." Health Affairs 23(6): 157-162, 2004.

Reprinted by permission from Visions, November 2004.

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